Clinical characteristics, complications, and predictors of outcome of hospitalized adult Sudanese patients with COVID-19 and malaria coinfection in Sudan: A multicenter retrospective cross-sectional study.

Malaria and coronavirus disease 2019 (COVID-19) share several characteristics that could lead to cross-infection, particularly in malaria-endemic areas. Early COVID-19 symptoms might be misdiagnosed for malaria in clinical settings. Also, both diseases can cause fatal complications. So, laboratory testing for both diseases was recommended by the World Health Organization. To study the clinical characteristics and outcomes of Adult Sudanese patients with COVID-19 and malaria coinfection. This retrospective cross-sectional study was conducted from January 2021 to October 2021 in Wad Medani. Total coverage of all Sudanese patients above 18 years old with a confirmed diagnosis of coinfection with COVID-19 and malaria was included, and data were collected using a data collection sheet. Data were analyzed using R software version 4.0.2. Data were described and presented as mean, standard deviation, and number (percentage). To find associated factors with in-hospital outcome, χ2 test, fisher exact test, and independent t test or Wilcoxon rank-sum test were used. In this study, 156 participants were diagnosed with COVID-19 and malaria coinfection. Most of them were between 60 and 70 years (30.8%), the majority were males (59%). Shortness of breath (76.3%) and acute respiratory distress syndrome (35.3%) were the most common symptom and complications among coinfected patients, respectively. Ground glass opacity (n = 47/49, 95.9%) is the most common result for computed tomography scan. Atrial fibrillation was the most common abnormal electrocardiogram finding (n = 6/62, 9.7%). Overall mortality among all participants was (63/156, 40.4%). High mortality rate was found among the coinfected patients. More attention is needed towards fighting COVID-19 and malaria coinfection. There may be a link between malaria and COVID-19.

The first record of Centrocestus formosanus (Nishigori, 1924) (Digenea: Heterophyidae) in Egypt.

The life cycle of Centrocestus formosanus (Digenea: Heterophyidae) was to be successfully completed in the laboratory in the present study. Hundreds of the thiarid snail, Melanoides tuberculata, were collected from the main water course Mansouriya Canal, Giza Governorate, Egypt. The snails were individually exposed to artificial light to determine possible infection with trematode larvae. Fifteen snails were found infected with opthalmopleurolophocercous cercariae (infection index of 1.97). These opthalmopleurolophocercous cercariae shedded from snails were collected and placed in an aquarium with fish intermediate host, Gambusia affinis, to obtain metacercariae encysted in the gills. The gills with metacercariae were fed to albino rats, Rattus norvegicus, to obtain the adult worms. Adult worms were recovered in the small intestine of rats at 7 days after infection and they were identified as Centrocestus formosanus based on the morphological characteristics and the comparison with the previous descriptions in the literature. They were small, 518 × 324 µm in average size and had characteristic 32 circumoral spines around the oral sucker. The morphological characteristics of the developmental stages, from cercariae to adults, of this heterophyid fluke were given here. Therefore, the presence of this fluke is to be confirmed for the first time in Egypt by the present study.

Extensive study of shape and surface structure formation in the mercury beating heart system.

A phenomenological study of the mercury beating heart system in a three electrode electrochemical cell configuration forced with a harmonic perturbation is presented. The system is controlled via a potentiostat, where the mercury drop is electrically connected to a platinum wire and acts as the working electrode. This configuration exhibits geometrical shapes and complex surface structures when a harmonic signal is superimposed to the working electrode potential. This study involves a wide range of frequencies and amplitudes of the forcing signal. Differents levels of structure complexity are observed as a function of the parameters of the applied perturbation. At certain amplitudes and frequencies, rotational behavior is also observed.

Haemodynamic support with percutaneous devices in patients with cardiogenic shock: the current evidence of mechanical circulatory support.

INTRODUCTION: Cardiogenic shock (CS) is a complex life-threatening condition that results from primary cardiac dysfunction, leading to persistent hypotension and systemic hypoperfusion. Among the therapeutic options for CS are various percutaneous mechanical circulatory support (MCS) devices that have emerged as an increasingly effective hemodynamic support option. Percutaneous therapies can act as short-term mechanical circulatory assistance and can be split into intra-aortic balloon pump (IABP) and non-IABP percutaneous mechanical devices. AREAS COVERED: This review will evaluate the MCS value while considering the mortality rate improvements. We also aim to outline the function of pharmacotherapies and percutaneous hemodynamic MCS devices in managing CS patients to avoid the onset of end-organ dysfunction and improve both early and late outcomes. EXPERT OPINION: Given the complexity, acuity and high mortality associated with CS, and despite the availability and efficacy of pharmacological management, MCS is required to achieve hemodynamic stability and improve survival. Various percutaneous MCS devices are available with varying indications and clinical outcomes. The rates of early mortality and complications were found to be comparable between the four devices, yet, IABP seemed to show the most optimal clinical profile whilst ECMO demonstrated its more long-term efficacy.

Outcomes of Surgical Exploration of Acute Scrotal Pain Raising Suspicion of Testicular Torsion.

Background and objective Testicular torsion (TT) is a surgical emergency, affecting approximately one in every 4000 males under the age of 25 years annually in the United States. In this study, we aimed to determine the outcomes of emergency scrotal surgical exploration of cases that raised suspicion of TT presenting to Salmaniya Medical Complex (SMC), Bahrain's largest secondary and tertiary care center. Methods This was a retrospective cohort study. The data were collected from the hospital's electronic medical record software (I-SEHA). The data included patient age, Doppler ultrasound (DUS) findings prior to any surgical procedure, type of surgical procedure, and the surgical findings of that procedure. Results Of the 198 patients who underwent scrotal exploration, 141 had presented with signs and symptoms suggestive of TT. The mean age of the patients was 22.3 ±9.3 years. Doppler imaging was performed preoperatively on 135 out of 141 (95.7%) patients. After scrotal exploration, 91.4% of the patients were found to have TT. The proportion of patients with salvageable testis was 78.7%. Conclusions The study found that surgical exploration remains the definitive method in the management of acute scrotum in TT patients. Our findings are in line with those from other similar studies and meta-analyses.

Anakinra in hospitalized patients with severe COVID-19 pneumonia requiring oxygen therapy: Results of a prospective, open-label, interventional study.

OBJECTIVE: The aim of this study was to evaluate the efficacy of anakinra in patients who were admitted to hospital for severe COVID-19 pneumonia requiring oxygen therapy. METHODS: A prospective, open-label, interventional study in adults hospitalized with severe COVID-19 pneumonia was conducted. Patients in the interventional arm received subcutaneous anakinra (100 mg twice daily for 3 days, followed by 100 mg daily for 7 days) in addition to standard treatment. Main outcomes were the need for mechanical ventilation and in-hospital death. Secondary outcomes included successful weaning from supplemental oxygen and change in inflammatory biomarkers. Outcomes were compared with those of historical controls who had received standard treatment and supportive care. RESULTS: A total of 69 patients were included: 45 treated with anakinra and 24 historical controls. A need for mechanical ventilation occurred in 14 (31%) of the anakinra-treated group and 18 (75%) of the historical cohort (p < 0.001). In-hospital death occurred in 13 (29%) of the anakinra-treated group and 11 (46%) of the historical cohort (p = 0.082). Successful weaning from supplemental oxygen to ambient air was attained in 25 (63%) of the anakinra-treated group compared with 6 (27%) of the historical cohort (p = 0.008). Patients who received anakinra showed a significant reduction in inflammatory biomarkers. CONCLUSION: In patients with severe COVID-19 pneumonia and high oxygen requirement, anakinra could represent an effective treatment option and may confer clinical benefit. TRIAL REGISTRATION NUMBER: ISRCTN74727214.

ß-lactamases (bla TEM, bla SHV, bla CTXM-1, bla VEB, bla OXA-1 ) and class C ß-lactamases gene frequency in Pseudomonas aeruginosa isolated from various clinical specimens in Khartoum State, Sudan: a cross sectional study.

Background:Pseudomonas aeruginosa is a pathogenic bacterium, causing nosocomial infections with  intrinsic and acquired resistance mechanisms to a large group of antibiotics, including ß-lactams. This study aimed to determine the susceptibility pattern to selected antibiotics and to index the first reported ß-lactamases genes frequency in Ps. aeruginosa in Khartoum State, Sudan. Methods: 121 Ps. aeruginosa clinical isolates from various clinical specimens were used in this cross sectional study conducted in Khartoum State. Eighty isolates were confirmed as Ps.aeruginosa through conventional identification methods and species specific primers. The susceptibility pattern of the confirmed isolates to selected antibiotics was done following the Kirby Bauer disk diffusion method. Multiplex PCR was used for detection of seven ß-lactamase genes ( blaTEM, blaSHV, blaCTXM-1, blaVEB, blaOXA-1, blaAmpC and blaDHA). Results: Of the 80 confirmed Ps. aeruginosa isolates, 8 (10%) were resistant to Imipenem while all isolates were resistant to Amoxicillin and Amoxyclav (100%). A total of 43 (54%) Ps. aeruginosa isolates were positive for blaTEM, blaSHV, blaCTXM-1, blaVEB and blaOXA-1 genes, while 27 (34%) were positive for class C ß- Lactamases, and 20 (25%) were positive for both classes. Frequency of beta-lactamases genes was as follows: blaTEM, 19 (44.2%); blaSHV, 16 (37.2%); bla CTX-M1, 10 (23.3%); blaVEB, 14 (32.6%); blaOXA-1, 7 (16.3%). blaAmpC 22 (81.5%) and bla DHA 8 (29.6%).  In total, 3 (11.1%) isolates were positive for both bla AmpC and blaDHA genes. Conclusion:Ps. aeruginosa isolates showed a high rate of ß- lactamases production, with co-resistance to other antibiotic classes. The lowest resistance rate of Ps. aeruginosa was to Imipenem followed by Gentamicin and Ciprofloxacin. No statistically significant relationship between production of ß-lactamases in Ps. aeruginosa and resistance to third generation cephalosporins was found.

Interaction of phenoxybenzamine with muscarinic receptors and calcium channels.

Phenoxybenzamine (POB, 10(-6) - 10(-4) M) inhibited the responses of guinea pig ileal longitudinal smooth muscle to both muscarinic agonists and K+-depolarization but was more effective against the agonist-induced responses. POB inhibited binding of both the muscarinic antagonist [3H]quinuclidinyl benzilate (QNB) and the Ca2+ channel antagonist [3H]nitrendipine and was, paralleling its effects on mechanical responses, more effective against [3H]QNB binding. POB reduced specific [3H]QNB binding by a reduction in Bmax with no change in KD, but inhibited [3H]nitrendipine binding by reducing KD with no effect on Bmax. It is suggested that the activity of POB against Ca2+ channels may underlie the ability of POB, and other 2-halogenoethylamines, to inhibit a wide variety of apparently discrete pharmacological events.

Negative ion formation and motion in a mixture of CCl4 and Ar.

This paper deals with the measurement of the mobility of negative ions in the mixtures of CCl4 with Ar with the CCl4 ratio up to 33.3%. The pulsed Townsend technique was employed to produce an integrated ionic avalanche over a range of the density-reduced electric field E/N for which ionization is either negligible or absent, and attachment processes are dominant, leading to the formation of mostly CCl-4. The E/N range of measurement was 1-50 Td (1 Td=10(-17) V cm(2)). Our measurements strongly suggest that attachment is the dominant process and only negative ions are formed.

Negative ion motion in the mixtures of SF6 with CF4 and CH4-Ar.

This paper deals with the measurement of the mobility of negative ions in the mixtures of SF6 with CF4 and the CH4-Ar (50:50) binary mixture with SF6 contents up to 50%. The pulsed Townsend technique was used to observe the integrated ionic avalanches over a range of the density-reduced electric field E/N for which ionization is either negligible or absent, and attachment processes are significant, leading to the formation of mostly SF-6. The E/N range of measurement was from 1 to 70 Td (1 Td=10(-17) V cm(2)), over which the measured mobilities were found to be almost constant. The mobility of the negative ions was also measured for trace amounts of SF6 in CH4 and Ar and 1% CF4, thereby providing a good value of the mobility of SF-6 in these pure gases, in order to test the measured mobilities with Blanc's law. We have found good agreement, within quoted experimental uncertainties, between calculated and measured values.

Embryonic development and organogenesis in the snail Marisa cornuarietis (Mesogastropoda: Ampullariidae). V. Development of the nervous system.

The nervous system is ectodermal in origin. All nerve ganglia arise separately by proliferation and later delamination from the ectoderm, not by invagination. They become secondarily connected to one another by commissures and connectives developing as extensions from the peripheral layer of ganglionic nerve cells. Rudiments of the cerebral, pedal, pleural and intestinal (parietal) ganglia arise almost simultaneously at a relatively early stage (Stage V). The cerebral ganglia develop from the ectoderm of the head plates. Rudiments of the pedal and pleural ganglia are separate at their inception. They later fuse (Stage VI) to form a pleuro-pedal ganglionic mass on each side. The 2 intestinal ganglia are symmetrical at the beginning, but they soon lose their symmetry as a result of torsion. The right ganglion crosses to the left over the gut and persists as the supraintestinal ganglion. The left or subintestinal ganglion shifts to the right and forward, and fuses with the right pleural ganglion (Stage VIII), thus obscuring the chiastoneury. The paired buccal and single visceral (abdominal) ganglia start differentiating in Stage VII. The former develop from the ectodermal wall of the stomodaeum, while the visceral ganglion delaminates from the right wall of the visceral sac, then shifts to the left during torsion. The statocysts develop early (Stage V) from 2 ectodermal invaginations on either side of the rudimentary foot. They later separate from the overlying ectoderm and statoconi appear in their lumina. Contrary to earlier reports on related ampullariids, the osphradium proved to be ontogenetically older than the mantle and mantle cavity. It starts differentiating as a thickened ectodermal plate in the right wall of the visceral sac (Stage V). During torsion, it becomes engulfed in the mantle cavity and shifts to the left side, then is carried forward as the mantlegrow. The eyes develop late (Stage IX) as ectodermal invaginations which rapidly separate from the ectoderm to form closed vesicles. Their cells start differentiating before hatching to form the retina, in which pigment is deposited, and the inner cornea. The lens is secreted in the lumen of the eye and grows by addition of concentric layers of secretion.

Retention of forearm plates: risks and benefits in a paediatric population.

Most surgeons favour removing forearm plates in children. There is, however, no long-term data regarding the complications of retaining a plate. We present a prospective case series of 82 paediatric patients who underwent plating of their forearm fracture over an eight-year period with a minimum follow-up of two years. The study institution does not routinely remove forearm plates. A total of 116 plates were used: 79 one-third tubular plates and 37 dynamic compression plates (DCP). There were 12 complications: six plates (7.3%) were removed for pain or stiffness and there were six (7.3%) implant-related fractures. Overall, survival of the plates was 85% at 10 years. Cox regression analysis identified radial plates (odds ratio (OR) 4.4, p = 0.03) and DCP fixation (OR 3.2, p = 0.02) to be independent risk factors of an implant-related fracture. In contrast ulnar plates were more likely to cause pain or irritation necessitating removal (OR 5.6, p = 0.04). The complications associated with retaining a plate are different, but do not occur more frequently than the complications following removal of a plate in children.